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2024 Vol. 30, No. 8
Published: 2024-08-28
 
679 Comparative Study on Efficacy in Treatment of Double-Segmental Cervical Spondylosis with Two Anterior Surgical Approaches
Wang Xinyang，Wang Yingfeng，Han Jianbang，Li Yi，Huang Dingan
Objective〓To compare efficacy of anterior cervical discectomy and fusion(ACDF) and anterior cervical corpectomy and fusion(ACCF) in treatment of double-segmental cervical spondylosis.Methods〓102 patients underwent surgical treatment for double-segmental cervical spondylosis in Peoples’ Hospital of Huangshan City from January 2018 to June 2022 were retrospectively reviewed，and divided into ACDF group and ACCF group，according to surgical approach the patient received.ACDF group comprised 50 patients (22 males and 28 females)，mean age of (54.78±10.22) years.ACCF group included 52 patients (40 males and 12 females)，mean age of (56.06±10.32) years.Perioperative indexes，incidence rate of complications，excellent and good rate，visual analogue scale(VAS)，Japan orthopaedic association(JOA) score，neck disability index(NDI)，cervical Cobb angle，cervical range of motion(ROM)，ROM of adjacent upper and caudal segments，incidence rate of adjacent segment degeneration(ASD) were compared between the two groups.Results〓There was no significant difference in preoperative VAS，JOA score，NDI between the two groups(P＞0.05).Operation time，intraoperative blood loss，drainage volume，hospital stay and incidence rate of complications in ACDF group were significantly less than those in ACCF group(P＜0.05).All of the patients were followed up for 15 to 22 months with a mean time of (18.23±1.50)months.VAS，JOA score，NDI improved significantly in both groups(P＜0.05)，but there was no significant difference in excellent and good rate，cervical ROM，ROM of adjacent upper and caudal segments and incidence rate of ASD between the two groups at final follow-up(P＞0.05).The cervical Cobbangle in ACDF group was significantly larger than that in ACCF group(P＜0.05).Conclusion〓Both ACDF and ACCF produce a satisfactory operative efficacy in treatment of double-segmental cervical spondylosis，improving cervical and nervous function.However，both two approaches may lead to complications and ASD，partly restrict cervical movement.Comparatively，ACDF is less invasive，causes fewer complications and maintains better cervical curvature.
2024 Vol. 30 (8): 679- [Abstract] ( 198 ) HTML (1 KB)  PDF (2964 KB)  ( 143 )
686 Analysis of the Therapeutic Effect of Large-Channel Spinal Endoscopy Technique in the Treatment of Thoracic Ligamentum Flavum Ossification
Objective〓To retrospectively analyzed the clinical efficacy of the treatment of thoracic ossification of ligamentum flavum with unilateral laninotomy and bilateral decompression under Delta canal endoscopy.Methods〓A retrospective analysis was conducted on 13 patients with thoracic ossification of the ligamentum flavum who underwent Delta canal endoscopy between August 2019 and January 2022 in Weifang People’s Hospital.6 males and 7 females，aged 55 to 69 years，with a mean age of (62.62±4.01)years.Patient demographics and perioperative parameters were recorded，and follow-up assessments were performed at 1 month and 6 months postoperatively to document changes in pre-operative and post-operative modified Japanese orthopaedic association score (mJOA)，American spinal injury association sense score (ASS) and American spinal injury association motor score (AMS).The recovery rate and excellent rate based on mJOA scores at the 6-month follow-up were calculated，followed by correlation analyses between RR and gender，age，preoperative mJOA score，radiographic classification type，as well as disease duration.Results〓The mean operation time was (108.46±16.12) minutes，the average blood loss was (23.46±7.47) mL，and the mean length of hospital stay was (6.08±0.86) days.All patients completed the follow-up period，duration ranging from 6 to 35 months，averaging at (16.77±9.33) months.At 1-month and 6-month follow-up after surgery，mJOA，ASS，and AMS scores exhibited significant improvement compared to preoperative values (P＜0.05).The mean recovery rate was (55.69±19.73)% with a good-to-excellent rate of 69.23%.Preoperative disease duration showed a negative correlation with the recovery rate (P＜0.001)，while preoperative mJOA score demonstrated a positive correlation with the recovery rate (P＝0.029).No significant correlations were found between the recovery rate and gender，age or radiographic classification(P＞0.05).Conclusion〓The utilization of transforaminal endoscopic technique for the management of TOLF is deemed to be a safe and dependable approach，offering notable advantages such as rapid postoperative recovery，minimal invasiveness，and reduced intraoperative blood loss.Furthermore，it demonstrates favorable short-term outcomes.
2024 Vol. 30 (8): 686- [Abstract] ( 136 ) HTML (1 KB)  PDF (2855 KB)  ( 93 )
691 The Safety and Efficacy of Endo-ULBD Technique in the Treatment of Thoracic Ossification of the Ligamentum Flavum
Objective〓To evaluate the safety and efficacy of percutaneous endoscopic unilateral laminectomy for bilateral decompression (Endo-ULBD) in the treatment of thoracic ossification of the ligamentum flavum (TOLF).Methods〓A retrospective analysis was conducted on 28 patients with TOLF admitted to the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to January 2023.Among them，14 patients underwent Endo-ULBD surgery，comprising 7 males and 7 females，with ages ranging from 50 to 73 years old and a mean age of (61.79±8.33)years.The remaining 14 patients received traditional posterior laminectomy or combined fusion and fixation surgery，including 10 males and 4 females，with ages spanning from 50 to 70 years old and a mean age of (60.57±6.10)years.Comparisons were made between the two patient groups regarding general baseline data，surgical duration，hospital stay，intraoperative blood loss，postoperative visual analogue scale(VAS) scores for pain，Japanese orthopaedic association(JOA) scores，activities of daily living (ADL) scores，Oswestry disability index(ODI) scores，and the incidence of complications.Results〓The comparison of intraoperative blood loss and hospital stay duration between the two groups revealed significant statistical differences (P＜0.05)，whereas the difference in operation time was not statistically significant (P＞0.05).The VAS，JOA，ADL，and ODI scores of both groups at 1 month，6 months postoperatively，and at the final follow-up did not exhibit statistically significant differences (P＞0.05).However，within each group，the comparison of these indicators across different time points showed statistical differences (P＜0.05).In the Endo-ULBD group，there were no complications such as cerebrospinal fluid leakage，epidural hematoma，spinal nerve function deterioration，nerve damage，or incision infection.In contrast，the traditional surgery group reported 2 cases (14.2%) of cerebrospinal fluid leakage and 1 case (7.1%) of postoperative headache and neck pain.Conclusion〓Endo-ULBD is an effective and safe surgical method for the treatment of TOLF，including cases with dural ossification，
2024 Vol. 30 (8): 691- [Abstract] ( 118 ) HTML (1 KB)  PDF (3953 KB)  ( 95 )
696 Efficacy of Arthroscopic Modified Kite Technique Combined with Triple-Button in the Treatment of Acute Acromioclavicular Joint Dislocation
Objective〓To evaluate the clinical outcomes of arthroscopically assisted Improved Kite technique combined with Triple-button fixation in the surgical management of acute acromioclavicular joint dislocations.Methods〓A retrospective analysis was conducted on 33 patients treated with arthroscopic coracoclavicular ligament reconstruction using the Improved Kite technique combined with Triple-button fixation at Baoding No.1 Central Hospital and the Third Hospital of Peking University between December 2019 and May 2022.The study cohort included 21 males and 12 females，with ages ranging from 21 to 58 years (mean age：38.20±0.60 years).The affected side was the left shoulder in 20 patients and the right shoulder in 13 patients.Based on the Rockwood classification，16 patients were classified as Type Ⅲ and 17 as Type V dislocations.Preoperative and final follow-up assessments included the Visual Analogue Scale (VAS) for pain，Constant-Murley Scores (CMS) for shoulder function，and range of motion (ROM) measurements.Preoperative，postoperative，and final follow-up X-rays of the injured shoulder joint were obtained to measure the coracoclavicular distance (CCD) and acromioclavicular distance (ACD).Additionally，any complications encountered during or after the procedure were recorded.Results〓The 33 patients were followed up for 6 to 19 months，with a mean follow-up duration of (13.36±0.28)months.All surgical incisions healed without infection，and no complications such as recurrent dislocation，clavicle fractures，or coracoid fractures were observed.The VAS score significantly decreased from (7.44±0.53) preoperatively to (0.56±0.73) at the final follow-up (P＜0.001).The CMS improved significantly from (35.11±1.45) preoperatively to (90.11±2.80) at the final follow-up (P＜0.001).The forward elevation ROM of the injured shoulder improved significantly from (47.22±9.39)° preoperatively to (178.89±3.33)° at the final follow-up (P＜0.001).The coracoclavicular distance(CCD) decreased significantly from (16.73±3.73) mm preoperatively to (10.61±3.24)mm at the final follow-up(P＜0.001).Similarly，the acromioclavicular distance(ACD) also decreased significantly from (12.18±3.34)mm preoperatively to (6.49±2.64)mm at the final follow-up (P＜0.001).Conclusion〓The arthroscopically assisted Improved Kite technique combined with Triple-button fixation for the treatment of acute acromioclavicular joint dislocations is a safe and reproducible procedure that achieves satisfactory short-term clinical outcomes.However，further observation is required to assess its long-term efficacy.
2024 Vol. 30 (8): 696- [Abstract] ( 116 ) HTML (1 KB)  PDF (932 KB)  ( 129 )
701 Efficacy of Minimally Invasive Sacroiliac Fixation Combined with INFIX in the Treatment of Tile B Type Pelvic Fractures
Objective〓To assess the clinical effectiveness of minimally invasive sacroiliac fixation in conjunction with internal fixation(INFIX) for the management of Tile B type pelvic fractures.Methods〓A retrospective study was undertaken involving 41 patients diagnosed with Tile B type pelvic fractures and treated at Zhongshan Hospital of Traditional Chinese Medicine between June 2021 and June 2023.These patients were randomly allocated into two groups：An observation group (n＝20) receiving minimally invasive sacroiliac fixation combined with INFIX［male：13，female：7；age range：34~61 years，mean age：(47.1±8.1)years］and a control group (n＝21) undergoing open reduction and internal fixation［male：15，female：6；age range：32~58 years，mean age：(45.8±7.6)years］.Metrics including surgical duration，intraoperative blood loss，healing time，hospital stay duration，and visual analogue scale (VAS) pain scores were recorded and compared between the groups.Furthermore，fracture reduction quality was evaluated using the Matta score，and clinical functional outcomes were assessed with the Majeed score at the final follow-up.Additionally，the incidence of complications was compared across both groups.Results〓All patients were followed up for a period ranging from 6 to 18 months，with an average follow-up duration of (10.2±4.3)months.Key indicators，including surgical time，blood loss，and hospital stay，demonstrated the superiority of minimally invasive sacroiliac fixation combined with INFIX (P＜0.001).No statistically significant difference was noted in fracture healing time between the two groups (P＝0.536).Postoperative follow-ups revealed significant improvements in both VAS scores and Majeed scores compared to preoperative levels in both groups (P＜0.05)，with satisfactory fracture reduction outcomes achieved in both groups (P＝0.879).Notably，the observation group exhibited a lower incidence of complications (5.0%) compared to the control group (19.0%)，and this difference was statistically significant (P＜0.05).Conclusion〓Minimally invasive sacroiliac fixation in conjunction with INFIX emerges as a safe and effective treatment modality for Tile B type pelvic fractures，presenting itself as a viable and favorable therapeutic option for managing such injuries.
2024 Vol. 30 (8): 701- [Abstract] ( 128 ) HTML (1 KB)  PDF (3456 KB)  ( 118 )
706 Micro-CT Observation of Trabecular Bone of Femoral Head in Osteoporotic Femoral Neck Fracture
Objective〓To investigate the regions of structural vulnerability within the femoral head of patients suffering from osteoporotic femoral neck fractures，aiming to contribute insights into the underlying mechanisms of such fractures and inform future research endeavors.Methods〓Utilizing micro-CT scanning technology，we examined six femoral head specimens procured from patients ［(5 males and 1 female，aged 68~82 years，mean age (73.17±4.92)years；3 left-sided and 3 right-sided)］ with confirmed osteoporotic femoral neck fractures，admitted to Beijing Chao-Yang Hospital，Capital Medical University.High-resolution imaging enabled us to reconstruct and comprehensively analyze the bone microstructure in three distinct yet critical areas：The peripheral region of the femoral head，the supralateral quadrant of the femoral head，and the inferior aspect proximal to the fracture site within the femoral neck.Subsequently，we conducted a comparative analysis of bone structural parameters across these regions to identify potential areas of weakness.Results〓In comparing the supralateral region of the femoral head to its peripheral zones，no statistically significant variations were observed in trabecular separation，thickness，number，structural model index，trabecular connectivity density，tissue bone mineral density，volume bone mineral density，bone volume fraction，or bone surface/volume ratio (P＞0.05).However，three-dimensional reconstructions of the supralateral area revealed increased trabecular separation，decreased trabecular thickness，and a noticeable decrease in trabecular number，accompanied by a more rod-like trabecular structure，indicative of structural weakening.Contrastingly，the lowest region of the femoral neck fracture demonstrated statistically significant increases in trabecular thickness，bone mineral density，and bone volume fraction compared to the peripheral regions，while the bone surface/volume ratio and structural model index decreased significantly (P＜0.05).Despite this，trabecular separation，number，and connectivity density did not exhibit statistically significant differences (P＞0.05).Three-dimensional reconstructions highlighted that the trabecular thickness in the lowest region of the fracture was notably thicker than in the peripheral zones，exhibiting a more plate-like trabecular structure.Conclusion〓The supralateral region of the femoral head is a potentially weak structure that may be prone to fracture during sideways falls.There was no apparent bone weakness at the bottom of the fracture site in the medial aspect of the femoral neck.
2024 Vol. 30 (8): 706- [Abstract] ( 127 ) HTML (1 KB)  PDF (5687 KB)  ( 88 )
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